The Wisconsin Hospital Association Advocacy Team ranked sixth among all lobbying organizations in the number of hours logged at the State Capitol—1,808 hours in all—moving up from eighth in the previous six-month report. WHA directed nearly $237,000 toward advancing its public policy agenda, including battling issues like TABOR and the low Medicaid reimbursement rates. WHA moved up another notch and now ranks fourth in terms of dollars spent toward lobbying efforts over the past six months. Factoring out single-issue groups, WHA would be even higher in terms of their ranking.

"This ranking demonstrates WHA’s commitment to aggressively advance issues important to our members," said WHA President Steve Brenton. "The level of advocacy activity measured by this report reflects WHA member expectations and staff’s commitment to deliver a strong and unified message on behalf of Wisconsin’s community hospitals."

WHA Senior Vice President Eric Borgerding emphasized that the Association’s lobbying efforts cannot be successful without the equally important role our membership plays in advocacy efforts. "WHA member advocacy through building successful relationships with elected officials is critical when the time comes for members to act on an issue that is up for a vote in committee or on the floor. I cannot stress enough how invaluable it is to the success of the lobbying team’s efforts when I walk into a legislator’s office and hear that he/she heard from hospital staff in their district on a particular issue," Borgerding added.

The latest numbers demonstrate WHA’s continued commitment to strong lobbying, but coupled with the growing advocacy efforts of WHA members, WHA continues to be the premier voice of the health care industry.

Every six months organizations that employ lobbyists must report to the Wisconsin Ethics Board the amount and time spent attempting to influence the legislative and administrative rules process in Wisconsin. The Board released its current analysis of lobbying activity for the first six months of 2004 late last week.

Mary Starmann-Harrison, president/CEO of SSM Health Care of Wisconsin, has been tapped by the WHA Nominating Committee to serve as the Wisconsin Hospital Association’s 2005 chair-elect.

Starmann-Harrison has served in many leadership positions at WHA. She has been a member of the Board of Directors since 2000, has chaired the Public Policy Council since 2001, served on the Property Committee in 2003-2004, was a member of the Political Action Committee in 2001, joined the Executive Committee in 2003, and served on the Nominating and Awards Committee in 2002. She is also a member of the American Hospital Association Regional Policy Board 5.

Starmann-Harrison joined SSM in September 1998 and has worked in the health care field for the past 24 years. SSMHC/WI owns and operates St. Marys Hospital Medical Center in Madison, St. Clare Hospital & Health Services in Baraboo, and two nursing homes. SSMHC/WI also manages Boscobel Area Health Care and is affiliated with Upland Hills Health Care, Inc. in Dodgeville, Columbus Community Hospital and Stoughton Hospital Association. SSMHC/WI is a member of SSM Health Care located in St. Louis, MO.

A graduate of Arizona State University, Starmann-Harrison holds a master’s degree in health service administration, a bachelor’s degree in nursing and is a Fellow of the American College of Healthcare Executives. She resides in Madison with her husband and two children.

"In just a few short years Mary has established an impressive track record as an Association leader," said WHA President Steve Brenton. "Mary has a special affinity for advocacy and representation -- WHA’s core program activities. And the fact that Mary’s ‘day job’ includes hands-on involvement with real issues affecting both rural and urban hospitals bodes well for her upcoming tenure as WHA chair."

Next week The Valued Voice will feature several biographies of individuals who were nominated as directors to the WHA Board. The Nominating Committee report will be presented to members attending WHA’s Annual Meeting on September 16.

Senator Ron Brown (R- 31 SD) met with West Central Region hospital leaders on August 11 at Myrtle Werth Medical Center, Menomonie. Sen. Brown discussed his views on the Taxpayer’s Bill of Rights (TABOR) and why he did not support TABOR when the Senate was called to Madison at the end of July to consider the issue.

Sen. Brown said that frustration with taxes is the number one issue among his constituents. He reminded those present that property tax freeze bills were twice passed by the Legislature in the last session and twice vetoed. He reported he promised his constituents a chance to review and comment on a TABOR proposal before he would vote, and there was not enough time for that to happen in late July. Sen. Brown has been named chairman of the Select Committee on Government Relations that will look at possible statutory changes that would help local government reduce expenses, thus lowering the tax bite. Sen. Brown commented that the projected size of the Medicaid budget shortfall is real and that it will take much discussion and debate to come to a workable agreement for the program.

The WHA 2004 Annual Convention will be held September 15-17 at the Grand Geneva Resort in Lake Geneva. Registration materials are included in this week’s packet and are available at www.wha.org.

This year’s convention begins with Anne Woodbury, chief health advocate at the Center for Health Transformation. Woodbury will share her insights on the transformation of American health and health care. Following her presentation, panelists will provide their reaction. Thursday afternoon includes a panel discussion about the issue of hospital billing and collection from both a national and state perspective. The programming on Thursday will end with a look at California’s nurse staffing ratio and what it is like to lead a hospital through this staffing mire.

The deadline for booking a room at the Grand Geneva Resort has been extended to August 23. Reserve a room by calling 800-558-3417 and requesting a room in the WHA room block. For more information contact Sherry Rabuck, srabuck@wha.org, or Jenny Boudreau, jboudreau@wha.org, or call 608-274-1820.

WHA’s Medicaid Task Force will hold its second meeting next month. The group is charged with the task of describing Wisconsin’s current Medicaid program, identifying hospital payment issues requiring address, and recommending meaningful action steps to improve payment and decrease growing cost shifting that is contributing to rising health insurance premiums.

Without a doubt, Medicaid will be WHA’s top advocacy priority in 2005. Our Medicaid agenda is likely to be framed by a variety of challenging issues, including:

• A likely Medicaid budget deficit approaching $220 million for the current fiscal year…a challenge that may result in new calls for eligibility cuts and/or provider payment reductions;
• A legislative environment that is likely to feature renewed debate over a Taxpayers Bill of Rights (TABOR), which if enacted will challenge current and long-term funding streams for an already underfunded program; and
• Emerging patterns of growing disproportionate hospital financial impact resulting from inadequate Medicaid payments and varying patient mix…not a surprising development from a program that pays hospitals less than 60 cents on the dollar for patient care costs.

WHA’s Medicaid Task Force will likely identify at least three top hospital payment improvement priorities, including: restoration of Medicaid Graduate Medical Education (GME) dollars cut in 2003; significantly enhancing Wisconsin’s current Disproportionate Share Hospital (DSH) program to target higher payments to safety net hospitals; and meaningful inpatient and outpatient payment increases.

Finding revenue sources to pay the State of Wisconsin’s share of payment improvements will be a greater challenge than actually "spending" the much-needed dollars. The fact is that Medicaid has never been a politically popular program, especially compared to K-12 education spending, road building and tax cuts. While many lawmakers decry the "hidden tax" of cost shifting that is the direct result of Medicaid underfunding, the political will to actually support the Medicaid program with real dollars has been absent—in good economic times and bad.

Here’s a prediction that WHA’s greatest challenge next year will be to gain a broad member consensus that embraces adequate Medicaid funding as a statewide — not just regional or hospital-specific — advocacy priority. Success in reaching that consensus will ultimately prove to be the single greatest determinant of the ultimate outcome in advancing a Medicaid agenda.

Steve Brenton,
President

Starting in Federal Fiscal Year 2005 (October 1), 99% of Wisconsin’s PPS hospitals will be eligible to receive the full market basket payment from the Centers for Medicare & Medicaid Services — an increase of 3.3% — because they submitted quality data on ten medical services measures of care.

MetaStar, Wisconsin’s Quality Improvement Organization, was instrumental in ensuring that Wisconsin hospitals completed the steps necessary to be eligible for the full market basket payment.

"This is yet another indication of the willingness of Wisconsin hospitals to be accountable for reporting quality measures," said WHA President Steve Brenton. "Our hospitals have embraced the reporting of evidence-based clinical measures that have been proven to improve outcomes. This commitment to the CMS initiative, which begins to link payment to performance, is a positive development."

The Centers for Medicare and Medicaid Services (CMS) has released the proposed calendar year 2005 Medicare Outpatient Prospective Payment System (PPS) rule, which is scheduled for publication in the August 16 Federal Register. Comments will be accepted until October 8 and a final rule is scheduled to be published by November 1. A display copy of the rule is available online at www.cms.hhs.gov/providers/hopps/2005p/1427p.asp.

Major provisions of the proposed rule include:

• The proposal incorporates the inpatient wage index from the proposed Inpatient PPS rule, including redefined wage areas and an occupational mix adjustment. CMS indicates that that the final inpatient wage index will be used in the final outpatient rule.
  
• The proposed 2005 conversion factor is $57.098, compared to $54.561 in 2004, a 4.6% increase. This is the result of a 3.3% market basket update, a slight increase for budget neutrality, and a 1.17% increase due to a lower "carve-out" for pass-through payments in 2005.
  
• CMS proposes to change the outlier methodology to target payments for complex, expensive procedures. Currently, outlier payments are provided if the cost for a service exceeds 2.6 times the Ambulatory Payment Classification (APC) rate. For 2005, CMS proposes to require that costs must exceed 1.5 times the APC payment rate and exceed a $625 fixed dollar threshold. This would eliminate outlier payments for low cost services and provide higher outlier payments for relatively expensive procedures.

• CMS proposes to simplify payment for observation services by eliminating the requirement that hospitals document use of specific diagnostic tests. The rule also modifies the guidelines for counting patients’ time spent in observation care.
  
• Payments for many drugs, biological products, and radiopharmaceuticals will change significantly due to revisions required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

WHA is analyzing the proposed rule and will provide more details to WHA members as they become available.

Long-term care (LTC) differs from other forms of medical care. Instead of curing a patient, the care is designed to allow the patient to achieve an optimal level of functioning, according to a 2000 report by the U.S. Senate Special Committee of Aging. LTC is needed when an individual can no longer undertake simple, everyday activities.

Approximately 12.1 million Americans need assistance from others to carry out everyday activities, says a 1999 report by The Henry J. Kaiser Foundation. Public and private spending on LTC services was more than $127 billion in 1998. According to The Medstat Group’s report, "Medicaid Long-Term Care Expenditures in 1999," about $34.5 billion of that cost was paid for by individuals and families. The aging of the population is expected to result in a tripling of LTC expenditures in the next 40 years to $346 billion annually, says the 1999 report, "Long-Term Care: Medicaid’s Role and Challenges," by the Kaiser Commission on Medicaid and the Uninsured.

New to this year’s annual convention is a health care provider legal issues program. Top health attorneys from some of the best firms in the state will provide an overview and their unique analysis of the current hot topics in health care law, including: the Stark II, Phase II regulations; recent court action concerning the medical malpractice statutes and other matters; credentialing issues; hospital and physician transactions and ventures; payment discounts, and more.

This session will provide an excellent opportunity to discuss these important topics. In addition, WHA will apply for 5.5 hours of CLE credit for this program. Included in this week’s packet is the program brochure and registration form.

Representative Leah Vukmir (R-Wauwatosa) shared her views on health care workforce issues with members of WHA’s Workforce Development Council on August 12 at WHA headquarters in Madison. In her introductory remarks, Vukmir said her background, which includes a master’s degree in nursing and experience in Milwaukee as a pediatric nurse practitioner, has caused her to be viewed as a resident expert on health care issues in the State Capitol. She has been impressed with the trust accorded her as a legislator because of her health care background both from constituents and from fellow legislators who often consult with her on health care policy issues. Vukmir voiced her eagerness to get back to the Assembly in 2005 where she plans to start working on the statutes regulating advanced nurse prescriptive authority.

Representative Vukmir and the Council discussed transferability of credits between the Wisconsin Technical College System and the University of Wisconsin, legislative restrictions to professional scope of practice, and the lengthy licensure process that delays and discourages professionals from seeking to practice in Wisconsin. When asked about her view on staffing ratios and other mandated restrictions on workforce issues, Vukmir said she believes that government should not interfere in the health care marketplace regarding staffing, overtime or ratios.

The remainder of the Council agenda focused on workforce tasks and projects. The Council offered feedback on a draft of the 2003 workforce report, which is viewed as a premier communications tool for both legislative and public audiences. They also commented on a recruitment brochure that will be available soon on the WHA Web site, reviewed the progress of the Department of Workforce Development Select Committee on Healthcare, and discussed a white paper on Safe Patient Lifting and Transfer.

Good Samaritan Hospital, Merrill and Myrtle Werth Hospital, Menomonie, received notification from the Centers for Medicare & Medicaid Services that they are Wisconsin’s newest additions to the list of hospitals approved for Critical Access Hospital status.